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A clinical case of somatoform disorder illustrates the process of a type of psychotherapy informed by attachment theory and research that pays heed to motivational systems that differ from attachment, and to the dynamic tensions between attachment and other motivational systems. The multimotivational theory that underpins case formulation and psychotherapy interventions is based, congruently with Bowlby’s attachment theory, on evolutionary thinking and is summarized in the first section of the article. As a necessary premise to understanding the clinical case, the second section of the article briefly outlines current knowledge on infant attachment disorganization and its developmental sequelae, considered from the perspective of the evolutionary multimotivational theory. [ABSTRACT FROM AUTHOR]

Research on disorganization of infant attachment provides evidence that it can be caused not only by violent aggression or very early sexual abuse, but also by covert maltreating behavior, which includes the abdication of the caregiver’s responsibility to soothe the infant’s distress. This paper argues that both overtly abusive caregivers and merely “abdicating” caregivers may cause disorganization of infant attachment through a simultaneous and conflicting activation of the motivational systems governing attachment and survival defense in the infant. Other inborn motivational systems—regulating caretaking, competitiveness, and sexuality—are disorderly activated, during personality development, within the intra-family relationships of children whose infant attachment has been disorganized. The paper argues that conflicts and abnormal tensions between different motivational systems explain some paradoxical features of the interactions between abusers and abused, and allow for a better understanding of the interpersonal processes involved in the surfacing and exacerbation of dissociative symptoms in the abused. [ABSTRACT FROM PUBLISHER]

A taxonomy of basic motivational systems (reptilian, mammalian, and neo-mammalian), that emerged in phases during the course of millions of years, is proposed. These different phases did not replace each other, but became reorganized in the brain at different hierarchical levels. It is argued that (a) humans are an ultracooperative species and (b) high degrees of cooperation put strong selective pressures toward the development of sophisticated forms of intersubjective communication. These two developments had cascading effects on human evolution, creating both the conditions upon which humans were able to understand intentions, gestures, emotions, and, ultimately, the minds of others, and the emergence of language and symbolic forms of cultural evolution. Possible evolutionary steps that led to this ultracooperative survival strategy and some of their genetic mechanism, with special emphasis on a multilevel model of selection, are described, and the implications for psychotherapy and psychoanalysis are explored. [ABSTRACT FROM PUBLISHER]

In this comment to Paolo Stramba-Badiale’s description of his clinical case, I argue that the therapist’s acknowledgment of feelings of powerlessness both in self and in the patient, without surrendering to them and without untimely attempting to overcome them, is a major factor of therapeutic change in the treatment of dissociative adults who had been chronically traumatized since early childhood. Consideration of the dynamic tension between the motivational system engaged in coping with environmental threats (freezing-fight-flight-feigned death) and the care-seeking (attachment) system provides the background for the argument, together with the knowledge of the controlling interpersonal strategies that typically follow, during childhood, infant attachment trauma. [ABSTRACT FROM PUBLISHER]

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Freud viewed the unconscious as being roughly equivalent to dynamically repressed wishes, needs, and motivations. Findings from developmental psychology, cognitive psychology, psychoanalysis, and neuroscience over the past 40 years have dramatically changed our views of unconscious processes and the human mind. It is now clear that Freud's dynamic unconscious is only a minor segment of information that is processed at subsymbolic, implicit, and automatic levels. Only a fraction of this information is further processed at explicit conscious levels. Moreover, the vast majority of the information that remains nonconscious is adaptive and has major consequences for development. We examine some clinical implications of these views. [ABSTRACT FROM AUTHOR]

The article offers an historical review of studies on the role played by attachment processes in dissociative psychopathology. The treatise proceeds from Bowlby's first insights, through Main and her collaborators' empirical studies on attachment disorganization, to the first formulation of the hypothesis linking disorganized early attachment to pathological dissociation. Recent research supporting the hypothesis is then reviewed. It is concluded that infant attachment disorganization is in itself a dissociative process, and predisposes the individual to respond with pathological dissociation to later traumas and life stressors. Four implications of this theory are interspersed in the re- view and are discussed in the final section: (I) pathological dissociation should be viewed as a primarily intersubjective reality hindering the integrative processes of consciousness, rather than as an intrapsychic defense against mental pain; (2) early defenses against attachment-related dissociation are based on interpersonal controlling strategies that inhibit the attachment system; (3) dissociative symptoms emerge as a consequence of the collapse of these defensive strategies in the face of events that powerfully activate the attachment system; (4) psychotherapy of pathological dissociation should be a phase-oriented process focused primarily on achieving attachment security, and only secondarily on [ABSTRACT FROM AUTHOR]